Kidney transplantation
From Biocrawler, the free encyclopedia.
Kidney transplantation or renal transplantation is the organ transplant of a kidney in a patient with chronic renal failure or some renal tumors. The main types are cadaveric and living donor transplant. In the former, the kidney originates from a deceased person. In the latter, the kidney is being donated by an organ donor.
The first succesful kidney transplantation was done in 1954 in Boston. The transplantation was done between identical twins, to eliminate any problems of an immune reaction. It was actually the first successful human organ transplant in history. The kidney was the easiest organ to transplant, tissue-typing was simple, the organ was relatively easy to remove and implant, live donors could be used without difficulty, and in the event of failure kidney dialysis was available from the 1940s. Tissue-typing was essential to the success, early attempts in the 1950s on sufferers from Bright's disease had been very unsuccessful.The transplantation was done by Dr. Joseph E. Murray, who received the Nobel Prize for Medicine in 1990. The recipient is still alive as of 2005, the donor passed away a few years after the transplantation.
Occasionally, the kidney is transplanted together with the pancreas. This is done in patients with diabetes mellitus type I, in whom the diabetes is due to destruction of the beta cells of the pancreas and in whom the diabetes has caused renal failure (diabetic nephropathy). This is cadaveric by definition, as a living donor could not live without a pancreas. This can pose a dilemma when the patient has potential living donor candidates.
The donor and recipient have to be HLA (tissue type) identical, and should ideally share as many "minor antigens" as possible. This decreases the risk of transplant rejection and need for dialysis and a further transplant. The risk of rejection after transplant may be reduced if the donor and recipient share as many HLA antigens as possible, if the recipient is not already sensitized to potential donor HLA antigens, and if immunosuppressant levels are kept in an appropriate range.
Problems after a transplant may include:
- Transplant rejection (hyperacute, acute or chronic)
- Infections and sepsis due to the immunosuppressant drugs that are required to decrease risk of rejection
- Post-transplant lymphoproliferative disorder (a form of lymphoma due to the immune suppressants)
- Imbalances in electrolytes including Calcium and Phosphate which can lead to bone problems amongst other things
- Other side effects of medications including gastrointestinal infammation and ulceration of the stomach and esophagus, hirsutism (excessive hair growth in a male-pattern distribution), hair loss, obesity, acne, diabetes mellitus (type 2), hypercholesterolemia and others.
Kidney transplant statistics
| Country | Cadaveric transplants | Living donor transplants | Total transplants | |
| Canada | 724 | 388 | 1,112 (in 2000) | [1] (http://www.hc-sc.gc.ca/english/organandtissue/facts_faqs/index.html) |
| France | 1,991 | 136 | 2,127 (in 2003) | [2] (http://www.uktransplant.org.uk/ukt/images/gifs/stats/european_activity_comparison_2003.gif) |
| Italy | 1,489 | 135 | 1,624 (in 2003) | |
| Spain | 1,991 | 60 | 2,051 (in 2003) | |
| United Kingdom | 1,297 | 439 | 1,736 (in 2003) | [3] (http://www.uktransplant.org.uk/ukt/statistics/general_statistics/transplants_performed_2002_2003.jsp) |
| United States | 8,670 | 6,468 | 15,138 (in 2003) | [4] (http://www.optn.org/latestData/step2.asp) |
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![[2]](http://www.uktransplant.org.uk/ukt/images/gifs/stats/european_activity_comparison_2003.gif){kind=link}